Expert Interviews

AAD 2025. Peter Lio, MD, from the Feinberg School of Medicine in Chicago, says, skip the elimination diet because food is rarely a cause of atopic dermatitis.

There are 3 classes of nonsteroidal topical therapies for atopic dermatitis that target the specific underlying pathophysiology of the skin disease. Shahriari provides a primer as physicians prepare for AAD 2025.

Panelists discuss how proper application technique and adherence are vital for topical atopic dermatitis treatments. Effective provider communication and primary care provider/dermatologist collaboration optimize patient outcomes through education and coordinated care. Primary care providers and dermatologists should coordinate care through clear communication, shared protocols, and defined referral pathways to optimize atopic dermatitis management and improve patient outcomes.

Panelists discuss how, based on clinical observations, atopic dermatitis imposes significant physical and mental burdens. Patients experience chronic itching, pain, and sleep disruption while experiencing psychological distress, social anxiety, and reduced self-esteem. Delayed diagnosis exacerbates these burdens, allowing disease progression and worsening quality of life.

Panelists discuss recent topical atopic dermatitis therapies, which include roflumilast (PDE4 inhibitor, age ≥ 6 years), ruxolitinib (JAK inhibitor, age ≥ 12 years), and tapinarof (hydrocarbon receptor agonist, age ≥ 2 years). Treatment selection considers disease severity, age, affected areas, comorbidities, and previous therapy responses.

Panelists discuss how the newer topical agents (PDE4 inhibitors, JAK inhibitors) demonstrate comparable efficacy to midpotency corticosteroids but with improved safety profiles, lacking steroid-related adverse effects such as skin atrophy, hypothalamic-pituitary-adrenal axis suppression, and tachyphylaxis when used long term.

Shahriari, assistant clinical professor of dermatology at Yale University School of Medicine, says greater understanding of the condition has expanded the population for the diagnosis.

Panelists discuss how older topical treatments such as corticosteroids, calcineurin inhibitors, and crisaborole have limited efficacy with prolonged use. Corticosteroids cause skin thinning and systemic absorption on large body surface area (BSA). Calcineurin inhibitors and crisaborole show modest efficacy, with application site reactions.

Panelists discuss how atopic dermatitis diagnosis in primary care relies on clinical features including pruritus, characteristic distribution, and chronic/relapsing course. Severity assessment involves examining extent, intensity, impact on quality of life, and response to previous treatments.

Not all atopic dermatitis requires treatment by a specialist, says this dermatologist, and she collaborates regularly with her primary care colleagues.